Sine the immune system declines with advancing age, therefore older people are more susceptible to coronavirus (COVID-19) infection.

https://www.vox.com/2020/3/12/21173783/coronavirus-death-age-covid-19-elderly-seniors

The immune system in older adult is usually weak and we need strong immune system to fight viral illness. As we age, the thymus and bone marrow produce less of the vital B and T cells, which are key players in the immune system.

The age spectrum of those most affected by the current COVID 19 pandemic parallels that seen during other recent coronavirus outbreaks (i.e. MERS and SARS). As a consultant working in Saudi Arabia I am most familiar with MERS. Most children who are infected with MERS Cov never develop symptoms.

I believe that although children do get infected (i.e. are not completely spared); the manifestation of coronaviral diseases is milder in children than in adults. This is generally the case in most respiratory illnesses. I agree that the age-related reduction in innate immunity is likely to be very relevant. Changes in hydration status may also be relevant. However, this is not the whole story.

Unlike adults, children are generally physically fit, do sufficient exercise and, get adequate rest. The adults with MERS, SARS and COVID 19 who died usually had other comorbidities (e.g. diabetes, hypertension and ischaemic heart disease). These comorbidities significantly reduce physiological reserve. So children may simply be better able to 'fight off' coronaviral infections.

Swedish researchers have reported that nitric oxide inhibits replication of the virus. The elderly have lower levels of NO than youngsters.

Thank you @Sawsan, @Rajkumar and @Thomas for answering.

I am not worried about asking stupid questions. I am worried about losing precious time.

Economic activity is slowing everywhere and in a few weeks we may find hundreds of thousands of people (not monkeys) fighting for food. Also, most of the world´s leaders of all types (politicians, scientists, technologists, social en economical) and their replacements are in the high risk groups.

Even if vaccines or antivirals can be developed, how much can we produce shortly?

If the virus needs to stick itself to lung tissue first, are there ways that we can prevent it- or hinder it- from doing so?

The decreased hydration levels of older people is the basis for the close association between space medicine and gerontology. Literally, people start drying out. Can this be a contributing factor to this groups´s vulnerability? What do we know about NO in the body?

A study found that the virus can live less on copper than on aluminum steel. Is it because copper is toxic or is it because copper is a better conductor of heat and electricity?

Many devices that are used in winter to heat homes dry the air. Air conditioning can do so too. Can these be contributing factors? We cannot recommend people solutions before tests are done. And most of us do not have access to labs with the adequate equipment to run tests. But we can colaborate other ways and we better do it quickly, I think. Vaccines are antivirals are great but they won´t be able to reach people soon. We need to find palliative solutions that can be adopted by thousands, hundreds of thousands or millions of people and that get us more time.

Humans were able to find out how to use fire and wheels with brains much less developed than ours. Is it possible that we cannot find ways to fight this pest? I hope not.

The activity of immune system reduces as we age, thereby , an older man or woman will be prone to diseases compare to younger one due to increase in immune system.

Sine the immune system declines with advancing age, therefore older people are more susceptible to coronavirus (COVID-19) infection.

https://www.vox.com/2020/3/12/21173783/coronavirus-death-age-covid-19-elderly-seniors

It more affects the weak immune system.

Article Checklist Proformas to Guide and Document the Assessment of ...

Thank you @Maria for initiating this interesting discussion. I am also keen to improve the outcomes of patients during this pandemic. I believe the increased susceptibility of older patients to COVID 19 is multifactorial.

Many of this cohort will require support in intensive therapy units (ITUs). There is no country in the world that has sufficient ITU capacity to match the demand in the current pandemic. We must, therefore, enlist the assistance of staff who do not routinely work in ITU.

As the COVID 19 pandemic progresses we will need to upskill these colleagues to facilitate the assessment and treatment of critically ill patients with and without COVID 19. This may be achieved by face-to-face education sessions. However, this is very labour intensive and may increase spread of COVID 19 amongst healthcare professionals.

An alternative approach would be to use standardised checklist proformas for the assessment of critically ill patients (see link above).

The use of checklist proformas can facilitate the management of critically ill patients by staff who do not routinely work in ITUs. This could improve outcomes in this high risk cohort of patients and improve the confidence of staff redeployed to ITUs from other care areas.

I do agree with all the answers below that as we age, the immune system goes does but toddlers do have a weak immune system as well and not a single study shows in which toddlers are getting infected by the coronavirus.

Thank you all for taking time to answer this question.

Thank you Rajkumar for sharing your checklists.

I also believe the increased susceptibility of older patients to COVID 19 is multifactorial. I also think that quarantine in isolation may help increase the toll. This group knows that they need support because they do not trust their bodies since they can see how their body functions steadily decrease. They have reduce confidence on their own ability to control their environment even in normal situations. This increases their anxiety when the unexpected comes up. Even positive events can be expected with increasing anxiety. So I think that we probably need networks for the elderly to provide support and emotional containment.

I too think it may be related to multifacrtorial; however, the loss of the endothelial glycocalyx with aging is known to be present in mice and humans. Since ecGCx is the 1st barrier to the capillaries and maybe shed due to toxic cytokine - cytokine and reactive oxygen/nitrogen (RONS) STORM following infection and possible vascular collapse our younger healthier individuals may have greater protection as compared to older individual who have a marked reduction in ecGCx.

Great question and good discussions regarding this important topic - questons.

Melvin R Hayden

There is a general misunderstanding about old age, thinking that old people have a weaker immune system. In reality, as older people have much larger chance in contact with all different sorts of pathogens, they have developed much stronger adaptive immune systems against different kind of pathogens. If old people are healthy without any latent or symbolic metabolic syndromes, they would be much more resilient to any illness and infections than younger people.

But the real problem with old age is that, old people have more or less latent or symbolic metabolic syndromes with chronic inflammations. Because of this, the strong immune systems of old people are impaired, and do not function properly. This might be the main reason of the triggering of cytokine storm when old people face infections like the COVID-19, like the situations in any autoimmune diseases.

These metabolic syndromes are associated with one's lifestyle, and can be rectified by modifying one's lifestyle. As a preventative measure, restrictive eating should be practiced, which is able to reduces the metabolic syndromes, reduce the possibility of cytokine storm if a person is infected, and promotes recovery from the possible infection.

Children do have a weak immune system, yet they are more healthy without any latent or symbolic metabolic syndromes, and their innate nonspecific immunity is enough to cope with the SARS-COV-2 virus.

Another important factor to consider when trying to interpret variation in mortality rates between age groups is differences in cultural interpretation of quality of life. This impacts the social and medical ethics and the delivery, limitation and withdrawal of life sustaining therapies.

In many Western cultures quality of life is valued far more than quantity of life. In those setting limitation and even withdrawal of life sustaining therapies are a common mode of death.

In many Eastern cultures quantity of life is valued more than quality of life. In these settings treatment limitations and withdrawals of therapy are rare. Admission to intensive therapy units and prolonged organ support are common. Mode of death is often cardiac arrest.

These differences are magnified when there are limited resources particularly in Western countries. The social and medical acceptance of treatment limitations is increased; this may significantly increase case fatality rates.

When considering this it is important to recognise that every culture places greater value on the quantity of life of younger individuals than older individuals.

Withdrawal of therapy is much less common in children than in the elderly.

Very interesting,

Thomas J. Burke , the nitric oxide theory is very interesting one.

How about the ACE2 receptors expression? does that play a role as it is more expressed in adults compared to children? What about the the reduced lung functional reserve in adults compared to children as a result of aging process?

https://www.sciencedirect.com/topics/medicine-and-dentistry/carbon-dioxide-excretion

Is there any role for fetal hemoglobin that predominates in the neonate and young infant? The oxyhemoglobin dissociation curve is shifted to the left in neonates because of fetal hemoglobin, meaning that the partial pressure of oxygen necessary to produce an oxyhemoglobin saturation of 50 % (the P 50 ) is only 19 mmHg, versus 27 mmHg with mature adult hemoglobin A. Could this be a protectim mechanism for the neonates compared to older children and adults?

I wish that an answer will be found soon and more lives will be saved,

Thanks Maria Laura Ferreyra for your question

Thank you all for your answers.

I think that there is not one answer for this question, We are considering physiological factors and cultural ones too (which place older people at increased risk in a different way).

Maybe there are also emotional factors to consider, since they are related to inflammations and chronic illnesses. Maybe also psychological factors such as self-esteem and family closeness also play a part.

Remember there are very old people (over 90 and even 100 years old) which have lived through several epidemics/pandemics. What makes them so resilient?